AMERICAN NURSES ASSOCIATION Congress on Nursing Practice and Economics Friday, February 9 and Saturday, February 10, 2007 SUMMARY Congress Members Present: Chairperson, Kathleen M. White, PhD, RN, CNAA, BC; Vice-Chairperson Karen Ballard, MA, RN; Esther Acree, RN, MSN, SpCl.NSG, BC-FNP; Susan A. Albrecht, PhD, RN, FAAN; Carolyn Baird, MBA, M.Ed, RNC (INSA); Mary L. Behrens, RN, MSW, FNP-C; Virginia Burggraf, DNS, RN, FAAN; Sally Burrows-Hudson, MS RN CNN (ANNA); Myra C. Carmon, EdD, CPNP,RN; Thomas Ray Coe, RN, MS, CNAA, FACHE; Stephanie Davis Burnett, MSN, RN, FNP, CRRN (ARN); John F. Dixon, MSN, RN, CAN, B (AACN-West); Emma L. Doherty, MA, RN; William R. Donovan, MA, RN; Bette M. Ferree, MSN, RN, APRN, BC; Susan Foster, MSN, APRN; Irmatrude Grant, MS, RN; Janet Y. Harris, RN, MSN, CNAA , BC; Kimberly A. Hickey, MSN, APRN, BC; Debra Hobbins, MSN, APRN; Patricia Leo Holloman, BSN, RN, CNOR; Bette K. Idemoto, PhD, RN, CCRN, CS; Sandra Gracia Jones, PhD, ARNP, CS, FAAN; Beverly Jorgenson, RNC, MSN, NNP; David M. Keepnews, PhD, JD, RN, FAAN; Patricia L. Keller, MSN, RN,BC; Patrick E. Kenny, EdD, RN, ACRN, CAN, BC, C; Jane Kirschling, DNS (AACN-East); Pamela A. Kulbok, DNSc, APRN, BC; Kathleen G. Lawrence, MSN, RN, CWOCN; Carla A. B. Lee, PhD, ARNP, BC, FAAN; Karen Leone-Natale, BSN, RN; Lori Lioce, MSN, RN; Jennifer H. Matthews, PhD, APRN , BC; Peter T. Mitchell, RN, CNP, MSN; Pamela Sue Neal, MSN-NA, RN, C-FNP; Catherine E. Neuman, MSH, RN, CNAP; Anne Mabe Newman, DSN, APRN, BC; Ann M. O'Sullivan, RN, MSN, CAN; Theresa Ann Posani, MS, RN, CNS; Elizabeth Poster, PhD, RN, FAAN; Robin R. Potter-Kimball, RN, MS, CNS,BC; Linda Riazi-Kermani, BSN, RN, CEN; Pauline F. Robitaille, RN, MSN, CNOR (AORN); Patricia Schlosser, RN; Cheryl K. Schmidt, PhD, RN; Sue Sendelbach, PhD, RN, CCNS (NACNS); Nancy Shirley, PhD, RN; Joanne Sikkema, MSN, ARNP; Karen J. Stanley, RN, MSN, AOCN, FAAN (ONS) (Day 1); Jeanne Surdo, RN, BSN, MA; LaTonia Denise Wright, JD, RN

Congress Members Absent: Carola M. Bruflat, RNC, MSN, WHNP/FNP (AWHONN); Patricia Kunz Howard, PhD, RN, CEN (ENA); Jackie R. Pfeifer, RN, BSN, CCRN-CSC; Cheryl-Ann Resha, MSN, EdD, RN; Karen J. Stanley, RN, MSN, AOCN, FAAN (ONS) (Day 2); Brian Thorson, MA, CRNA; Mary Mason Wyckoff, MSN, APRN, BC , CCNS

Congress Liaisons Present: Maureen Ann Nalle, PhD, RN; (Center for American Nurses [CAN]); Jean Ross, RN, (United American Nurses [UAN]) Congress Liaisons Absent: Sara A. McCumber, APRN,BC, (American Nurses Credentialing Center [ANCC]) ANA/ANCC/CAN Staff:

Linda J. Stierle, MSN, RN, CNAA,BC; Mary L. Buszuwski; Wylecia Wiggs Harris, MBA, CAE; Nancy Hughes, RN, BSN; Mary Jean Schumann MSN, RN, MBA, CPNP; Vernell P. DeWitty, RN, MSN, MBA; Isis Montalvo; David Paulson, PhD; Mary C. Smolenski, EdD, APRNBC, FNP; FAANP; Jerry Wolman; Rita Munley Gallagher, PhD, RN; Cynthia Haney, Esq.; Cheryl Peterson, MSN, RN; Patricia Rowell, PhD, RN; Marian E. Condon, RN, MS Janet Haebler, MSN, RN Kristen Welker-Hood, ScD, RN Vernice Woodland

Guests:

Rebecca M. Patton, MSN, RN, CNOR; Gail Keenan; Bonnie Niebuhr, MS, RN, CAE (by phone); Debra Simmons; Joan Stanley, PhD, RN, CRNP (by phone)

Reports 1

Staff were available to answer questions related to the reports which were posted on the CNPE website.

Nurse Competence in Aging ~ Mary Jean Schumann, Director, Department of Nursing Practice and Policy Center for Occupational and Environmental Health ~ Nancy L. Hughes, MS, RN, Director, Center for Environmental Health Center for American Nurses ~ Wylecia Wiggs Harris, MBA, CAE, Executive Director, Center for American Nurses NDNQI ~ Isis Montalvo, MBA, MS, Project Manager, NDNQI ICNM/2007 ANA Quadrennial ~ Cheryl Peterson, MSN, RN, Senior Policy Fellow, Nursing Practice and Policy GOVA ~ Rose Gonzalez, PhD(c), RN, Director, Government Affairs ANCC ~ Jerry Wolman, David Paulson, PhD and Mary C. Smolenski, EdD, APRNBC, FNP; FAANP on behalf of Jeanne Floyd, PhD, RN, CAE, Executive Director, American Nurses Credentialing Center Committee on Standards and Guidelines ~ CNPE will be receiving a new set of standards to review in the very near future; hospice and palliative care. The Psychiatric Scope and Standards have gone to publication and will be available for purchase in the near future

CNPII ~ A request for approval of the group’s strategic plan is being considered by the ANA Board of Directors. Discussions Logical Job Analyses ~ An overview of developing test instruments and the utilization of scopes and standards was provided. ANCC develops and maintains thirty (30) certification exams: • 8 nurse practitioner exams • 7 clinical nurse specialist exams • 3 other advanced practice exams • 6 specialty (generalist) exams • 6 other exams ANCC exams meet American Psychological Association’s Standards of Educational and Psychological Testing. ANCC is accredited by the American Board of Nursing Specialties (ABNS) and is a member of the National Commission for Certifying Agencies (NCCA). Major steps in examination development include: • Establishment of the purpose of exam, description of practice and target audience • Determination of the test blueprint (content; weights for major and sub-domains) • Development of test items (writing, reviewing, pre-testing) • Assembling of test forms • Setting of the passing standard • Administration and scoring of exams

2

All exams are developed in house with ANCC staff and in conjunction with 100 member panel. ANCC, in cooperation with various stakeholders, establishes the purpose of the exam, description of practice and target audience (for new exams). The scope and standards are used as a resource in establishing them. They aid in determining the test blueprint (content; weights for major and sub-domains). The test blueprint is developed through the results of a role delineation study The role delineation study discusses what is taking place in the practice setting. (RDS). Scope and standards and other specialty-specific documents (e.g., competency statements) are used in developing a list of work activities or knowledge statements for the RDS.

Future of the APRN Regulatory Environment ~ In 2004 - AACN and NONPF forwarded a proposal to the Alliance for APRN Credentialing to develop a consensus statement on credentialing of APRNs. Fifty stakeholder organizations were invited and 32 attended a conference in DC in June 2004. The APRN conference participants recommended creation of a smaller Work Group. The work group representing 21 organizations convened to address issues delineated by the APN Consensus Conference including: APN definition; Specialization; Sub-specialization; and, Regulation (accreditation, certification and licensure). The Consensus Group was convened because of concern about regulatory restriction; varied state requirements for licensure; the emergence of narrowly defined specialties; and, lack of understanding among certifiers, accreditors, educators, and boards of nursing. The consensus definition includes the following elements of an Advanced Practice Registered Nurse: • APRN is professional framework for 4 roles: CNM, CRNA, CCNS and CNP • Completed graduate education • Acquired specialized clinical knowledge and skills to provide direct patient care • Build on RN practice/competencies • Prepared to assume responsibility and accountability for use and prescription of pharmacologic and non pharmacologic interventions. Certification is a critical component of APRN regulation and occurs through a psychometrically sound and legally defensible method which meets recognized accreditation standards. To be certified, an APRN must demonstrate acquisition of APRN role competencies in conjunction with at least one population focus of practice. In addition, the APRN may also demonstrate attainment of nationally recognized specialty competencies. Educational preparation must be congruent with the area of certification. APRN regulation occurs at the role level and is based on: • Recognition of accredited APRN Program: • Nationally recognized APRN education standards and core competencies • Nationally recognized APRN role educational standards and competencies • Educational preparation in 1 APRN role in conjunction with at least one population foci • Recognition of nationally accredited and legally defensible professional certification process evaluating role and population focused competencies For regulatory purposes, APRNs should only be required to meet the standard for one nationally recognized/accredited certification process. There are 4 separate processes necessary for regulation of APRNs: Education, Accreditation, Certification, and Licensure (LACE). Each process should be conducted by a separate entity. However, all four must effectively interact and communicate. The APRN Joint Dialogue Group agreed to a joint process at the APRN Consensus Meeting in Fall 2006. The goal is to develop complementary papers dealing with APRN regulation. The Joint Dialogue Group is comprised of representatives of the APRN Consensus Work Group and the NCSBN APRN Advisory Group. The first meeting (held January 4, 2007)resulted in the following outcomes: • Agreed to Assumptions • Expected Outcomes/Goals • Identification of Similarities/Areas of agreement • Identification of Areas of Differing Approaches/Views • Agreed to Process and Timeline It was noted that there are a number of similarities between the perspectives of the two groups: • 4 APRN roles • Definition of APRN

3

• Broad educational preparation • Opportunities to evolve practice • Independent practitioners • Regulated by and within nursing • Need evidence of continued competence in area of practice • Need to license at a broad level The APRN Joint Dialogue Group agreed in principle that education, certification and scope of practice should be consistent and that all programs leading to APRN licensure must be accredited. Major Areas for Future Discussion for the APRN Joint Dialogue Group include: • Residency: meaning, number of hours, breadth of clinical experiences • Measuring entry-level and ongoing competence • Can competency be tested at role level without the population focus • Should there be one exam or more than one for licensure and certification • Criteria for blended programs • And MANY others The APRN Joint Dialogue Group will be meeting February 15-16, 2007 in Chicago, IL and March 8-9, 2007 in Washington, DC with a goal of completing a DRAFT paper by June 2007. The APRN Work Group continues to meet via teleconference and face-to-face. In the future, the APRN Work Group Report will be presented to the larger APRN Consensus Group. All Work group members will continue to inform the discussions of the Joint Dialogue. It is anticipated that complementary papers which will be broadly disseminated will be developed through the Joint Dialogue. In the upcoming meeting, ANA staff will directly quote the comments made by CNPE .

Disaster Preparedness ~ Since 9/11, ANA has been involved in many areas: • • • • •

Surge capacity – modeling, how many you need, e.g. materials (Personal Protective Equipment) Working with HHS, Department of Justice, AMA, AHA along with other nursing colleagues. Working to create a better legal environment, e.g. recognition of licensure, workers comp, The National Conference Commissioner’s of Uniform Sate Law. Looking at Broad Federal Disaster Planning, National Response Plan, National Incident Management system, Homeland Security. Standard of care, occupational safety and health. How do we integrate public health? The acute care system and response.

ESARVHP, a system set up for a federal registry and try to promote that ability to be able to move assets across the state has been established. The issue is whether states would be willing to share resources. ESARVHP will assist with standardization, so a “Type I” nurse from NY is equal to a “Type I” nurse in Louisiana. Further discussion ensued regarding other groups with which ANA is working to address the issue. Medical needs shelters were discussed. It was suggested that Principles for Nurse Volunteers which would consider the aftercare of the RN who participates in this kind of activity might be developed following the Quadrennial Conference.

Actions Posting for a 60 day comment period on NursingWorld: • • •

Utilization of Nursing Assistive Personnel in all Settings Safety Issues Related to Tubing and Catheter Misconnections Elimination of Violence in Advertising Directed Toward Children, Adolescents and Families

Forwarding to the ANA Board of Directors for adoption: •

Assuring Safe High Quality Health Care in Pre-K through 12 Educational Settings as revised.

4

• • • •

Barrier Use for Prevention of HIV Infection and Sexually Transmitted Disease as revised. Preventing Transmission of Bloodborne Disease Through Injection Drug Use as revised. Preventing Transmission of Bloodborne Pathogens in Healthcare Settings as revised. Principles on Environmental Health for Nursing Practice.

Endorsement of: •

The Public Health Nursing Shortage: A Threat to the Public’s Health

Approval of: •

Report on Competence and Competency up to page 3/line 14.

New Business CNPE members offered suggestions as to potential issues for consideration which included: • HPV vaccine • Non-RN supervision of RNs • Care for military nurses and their well-being. • Payment codes for RNs

Fall 2007 Meeting The meeting will be held on September 30 and October 1, 2007 at the ANA Headquarters in Silver Spring, MD.

Drafted:

February 20, 2007

5